TN 15 (12-04)

A. Policy - general

Set a MIE diary for the reasons in DI 26525.025B. at a time when the MIRS criteria will probably be met (see DI 28010.000 and DI 28015.000 for MIRS criteria), i.e.:

• An adult will require medical improvement related to the ability to work and the ability to perform substantial gainful activity (SGA).

• For title XVI children, the impairment(s) should no longer result in marked and severe functional limitations (i.e., should no longer meet, or medically or functionally equal the severity of the listings). See also DI 25235.005 and DI 25235.006 for additional guidelines for scheduling MIE CDRS in title XVI disabled child cases.

CAUTION: In scheduling the CDR, consider all impairments and case facts. Do not set a MIE diary when another impairment (s) exists which is chronic or progressive, or when adverse vocational factors at the time of diary maturity would preclude work even if medical improvement for the primary impairment is expected.

B. Policy - CDRs

1. Original Impairment(s) No Longer Disabling

Set an appropriate MIE diary for any reason in DI 26525.025B.

2. Original Impairment(s) Still Disabling

Rarely set an MIE diary after CDR. Program experience has demonstrated that most disabling medical conditions will remain static or continue to progress, unless an effective intervention occurs.

• Consider why, if MIRS criteria are not met after this CDR, you would expect them to be met at the next CDR.

• Set the MIE diary only when the case facts show the individual will almost certainly meet the MIRS cessation criteria as of the proposed diary date.

NOTE: A MIE diary after a CDR may be appropriate as of the end of the 3-year remission period in a case which meets or medically equals the cancer listings (13.00 or 113.00), or when a CDR was scheduled prematurely in a fracture case and healing will be completed shortly.

C. Policy - age guidelines

1. General

Generally, set the MIE diary to mature only up to age 54 1/2.

2. Exceptions

A MIE diary may be set to mature up to:

• age 64 1/2 for title XVI statutory blindness when the statutory blindness definition will no longer be met, or

• age 59 1/2 for individuals whose case facts indicate that recovery or remission is almost certain (e.g., surgery or current significant, sustained, and progressive improvement will result in cessation under the MIRS). Examples include certain cancers (follow DI 26525.010), leukemias, and lymphomas; fractures, dislocations, sprain; etc.

NOTE: Generally, set a MINE diary for individuals who will be age 54 1/2 or older at the time a MIE diary would mature, except in the limited situations above.

D. Policy - diary date

1. General

The MIE diary is always set for less than 3 years from the month of the current determination.

Set the MIE diary for no later than the current month plus 30 months, because of systems limitations.

Set the MIE diary no earlier than cessation under the MIRS may be reasonably expected.

Avoid multiple CDRs within a short period of time by setting a later, rather than earlier, diary date.

NOTE: See DI 26525.050 when a vocational therapy diary may be set before the proposed MIE diary.

2. Onset and Duration Guidelines

a. General

Generally, set the MIE diary for not less than:

• 6 months from the month of the current determination, and

• 12 months from the established onset date (i.e., do not set the diary before the end of the 12-month durational period).

b. Exceptions

The MIE diary may be set within 12 months of the established onset date in title XVI cases when:

• the individual is expected to no longer be statutorily blind, or

• medical onset is before adjudication, and the 12-month duration requirement will be met.

E. Definitions

Definitions for when the criteria for establishing medical improvement will be met:

1. Probably Be Met

Probably be met means that, given the individual case facts, there is substantial evidence that the individual will:

• have medical improvement related to the ability to work if an adult, or medical improvement if a title XVI child, and

• be able to work if an adult, or no longer have marked and severe functional limitations if a title XVI child.

2. Almost Certainly Be Met

Almost certainly be met means that the individual case facts provide convincing evidence that the individual is in the process of a full recovery or is experiencing significant, sustained, and progressive improvement, and will almost certainly:

• be able to perform work if an adult, or

• no longer have marked and severe functional limitations if a title XVI child.

F. Procedure - case evaluation

To set a timely MIE diary date, consider:

• age at MIE diary maturity

• clinical findings

• past response to therapy

• type of treatment

• duration

• expected clinical course of the impairment

• vocational factors at diary maturity.

G. Procedure - systems coding

Complete the diary block of Forms SSA-831-C3/U3 (item 17) and SSA-832-C3/U3 and SSA-833-C3/U3 (item 23) as follows:

1. Diary Type

Enter “MRN”.

2. Diary Date

See DI 26525.020D. for guidance. Enter “01” for the day. Set a date no later than the current month plus 30 months, because of systems limitations.

3. Diary Reason

See DI 26525.025B. for MIE criteria and reason codes.

H. Reference

SSA-831-U3 diary coding instructions, DI 26510.020B.